Hydroxychloroquine Generic (Plaquenil) US$ 0.80 ea

1. What hydroxychloroquine sulfate is and what it is used for

Hydroxychloroquine sulfate works by reducing inflammation in people with autoimmune diseases (this is where the body’s immune system attacks itself by mistake).

It can be used for:

• Rheumatoid arthritis (inflammation of the joints)
• Juvenile idiopathic arthritis (in children)
• Discoid and systemic lupus erythematosus (a disease of the skin or the internal organs)
• Skin problems which are sensitive to sunlight

2. What you need to know before you take hydroxychloroquine sulfate

Do not take hydroxychloroquine sulfate if:

• You are allergic (hypersensitive) to:
  • hydroxychloroquine
  • other similar medicines such as quinolones and quinine
  • any of the other ingredients of hydroxychloroquine sulfate (listed in section 6)
    Signs of allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue.
• You have an eye problem which affects the retina, the inside of the eye (maculopathy) or you get a change in eye colour or any other eye problem.

Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking hydroxychloroquine sulfate.

Warnings and precautions

Talk to your doctor or pharmacist before taking hydroxychloroquine sulfate if:

• You have liver or kidney problems.
• You have serious stomach or gut problems.
• You have heart problems.
• You have any problems with your blood. You may have blood tests to check this.
• You have any problems with your nervous system or brain.
• You have psoriasis (red scaly patches on the skin usually affecting the knees, elbows and scalp).
• You have had a bad reaction to quinine in the past.
• You have a genetic condition known as ‘glucose-6-dehydrogenase deficiency’.
• You have a rare illness called ‘porphyria’ which affects your metabolism.

Before treatment with hydroxychloroquine sulfate

• Before you take this medicine you should have your eyes examined.
• This testing should be repeated at least every 12 months whilst taking hydroxychloroquine sulfate.
• If you are over 65, need to take a high dose (2 tablets a day) or have kidney problems then this examination should be performed more often.
• Hydroxychloroquine can cause lowering of blood glucose level. Please ask your doctor to inform you of signs and symptoms of low blood glucose levels. A check of the blood glucose level may be necessary.

If you are not sure if any of the above applies to you, talk to your doctor or pharmacist before taking hydroxychloroquine sulfate.

Other medicines and hydroxychloroquine sulfate

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because hydroxychloroquine sulfate can affect the way some other medicines work. Also some medicines can affect the way hydroxychloroquine sulfate works.

In particular, tell your doctor if you are taking any of the following:

The following medicines may increase the chance of you getting side effects when taken with hydroxychloroquine sulfate:

• Some antibiotics used for infections (such as gentamicin, neomycin or tobramycin).
• Cimetidine – used for stomach ulcers.
• Neostigmine and pyridostigmine used for muscle weakness (myasthenia gravis).
• Medicines that may affect the kidneys or liver.
• Medicines that affect the skin or the eyes.
• Halofantrine, mefloquine used for malaria.
• Amiodarone used for heart problems.
• Moxifloxacin used to treat infections.
• Medicines used for epilepsy.

The following medicines can change the way hydroxychloroquine sulfate works or hydroxychloroquine sulfate may affect the way some of these medicines work:

• Digoxin used for heart problems.
• Medicines for diabetes (such as insulin or metformin).
• Antacids used for heartburn or indigestion. You should leave a gap of at least 4 hours between taking these medicines and hydroxychloroquine sulfate.
• Rabies vaccine.
• Ciclosporin used after an organ transplantation to help prevent rejection.
• Praziquantel used to treat worm infections.
• Agalsidase used to treat a rare condition called Fabry™s disease.

Pregnancy and breast-feeding

Use of this medicine is not recommended during pregnancy. If you discover that you are pregnant or are planning to have a baby, consult your doctor right away to re-assess the need for treatment.

Do not take hydroxychloroquine sulfate if you are breast-feeding or planning to breast-feed. This is because small amounts may pass into mother™s milk. Ask your doctor or pharmacist for advice before taking any medicine if you are pregnant or breast-feeding.

Driving and using machines

You may get eye problems while taking this medicine. If this happens, do not drive or use any tools or machines, and tell your doctor straight away.

Hydroxychloroquine sulfate contains lactose

If you have been told by your doctor that you cannot tolerate some sugars, talk to your doctor before taking hydroxychloroquine sulfate.

3. How to take hydroxychloroquine sulfate

Always take hydroxychloroquine sulfate exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

Taking this medicine

• Take this medicine by mouth.
• Swallow the tablets whole with a meal or a glass of milk. Do not crush or chew your tablets.
• If you are taking this medicine for skin problems that are sensitive to sunlight, only take hydroxychloroquine sulfate during periods of high exposure to light.
• The doctor will work out the dose depending on your body weight. If you feel the effect of your medicine is too weak or too strong, do not change the dose yourself, but ask your doctor.
• If you have been taking this medicine for rheumatoid arthritis for a long time (more than 6 months) and you do not feel that it is helping you, see your doctor. This is because the treatment may need to be stopped.

How much to take

Adults (including the elderly)

• One or two tablets each day.

Children and adolescents

• One tablet each day.
• This medicine is only suitable for children who weigh more than 31 kg (around 5 stones).

It may take several weeks before you notice the benefit of taking hydroxychloroquine sulfate.

If you take more hydroxychloroquine sulfate than you should

• If you take more hydroxychloroquine sulfate than you should, tell your doctor or go to a hospital casualty department straight away. Take the medicine pack with you. This is so the doctor knows what you have taken. The following effects may happen: headache, problems with your eyesight, fall in blood pressure, convulsions (fits), heart problems, followed by sudden severe breathing problems and possibly heart attack.
• Young children and babies are particularly at risk if they accidentally take hydroxychloroquine sulfate. Take the child to hospital straight away.

If you forget to take hydroxychloroquine sulfate

If you forget a dose, take it as soon as your remember it. However, if it is nearly time for the next dose, skip the missed dose. Do not take a double dose to make up for a forgotten tablet.

If you stop taking hydroxychloroquine sulfate

Keep taking hydroxychloroquine sulfate until your doctor tells you to stop. Do not stop taking hydroxychloroquine sulfate just because you feel better. If you stop, your illness may get worse again.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, hydroxychloroquine sulfate can cause side effects, although not everybody gets them.

Stop taking hydroxychloroquine sulfate and see a doctor or go to a hospital straight away if:

Not known (frequency cannot be estimated from available data)

• You have an allergic reaction. The signs may include: a red or lumpy rash, swallowing or breathing problems, swelling of the eyelids, lips, face, throat or tongue.
• Severe skin reactions such as blistering, widespread scaly skin, pus-filled spots together with a high temperature, reddening and being more sensitive to the sun.
• Blistering or peeling of the skin around the lips, eyes, mouth, nose and genitals, flu-like symptoms and fever. This could be a condition called Stevens-Johnson Syndrome.

Stop taking hydroxychloroquine sulfate and see a doctor straight away if you notice any of the following serious side effects you may need urgent medical treatment:

Common side effects (may affect less than 1 in 10 people)

• You have any eye problems. This includes changes in the colour of your eye and problems with your eyesight such as blurring, sensitivity to light or the way you see colour.

Uncommon side effects (may affect less than 1 in 100 people)

• You have any muscle weakness, cramps, stiffness or spasms or changes in sensation such as tingling. If you take this medicine for a long time, your doctor will occasionally check your muscles and tendons to make sure they are working properly.

Not known (frequency cannot be estimated from available data)

• You have frequent infections such as fever, severe chills, sore throat or mouth ulcers. These could be signs of a blood problem called ˜leucopenia™ or ˜agranulocytosis™.
• You may bruise more easily than usual. This could be due to a blood problem called ˜thrombocytopenia™.
• You feel tired, faint or dizzy and have pale skin. These could be symptoms of something called ˜anaemia™.
• You feel weak, short of breath, bruise more easily than usual and get infections more easily than usual. These could be symptoms of something called ˜aplastic anaemia™.
• Weakening of the heart muscle (cardiomyopathy) resulting in difficulty breathing, coughing, high blood pressure, swelling, increased heart rate, low amount of urine.
• Low blood sugar levels (hypoglycaemia). You may feel a sense of nervousness, shaky or sweaty.
• You notice yellowing or your skin or your eyes or your urine becomes darker in colour. This could be a liver problem, such as jaundice or hepatitis.
• Fits.
• Lack of movement, stiffness, shaking or abnormal movements in the mouth and tongue.

Tell your doctor or pharmacist if any of the following side effects get serious or lasts longer than a few days:

Very common side effects (may affect more than 1 in 10 people)

• Stomach pain
• Feeling sick

Common side effects (may affect less than 1 in 10 people)

• Skin rashes, itching
• Being sick, diarrhoea
• Loss of appetite (anorexia)
• Headache
• Changes in mood with uncontrollable laughing or crying

Uncommon side effects (may affect less than 1 in 100 people)

• Changes in the colour of your skin or the inside of your nose or mouth
• Hair loss or loss of hair colour
• Feeling nervous
• Ringing in the ear (tinnitus)
• Balance problems (vertigo) or feeling dizzy
• Liver problems shown by blood tests

Not known (frequency cannot be estimated from available data)

• Psoriasis (red scaly patches on the skin usually affecting the knees, elbows and scalp)
• Hearing loss
• Mental problems (such as delusions, hallucinations and changes in mood)
• Symptoms of a condition called ˜porphyria™ which may include stomach pain, being sick, fits, blisters, itching

Tests

Your doctor may monitor:

• Your heart™s electrical activity using an ECG (electrocardiogram) machine.
• Your muscle function and tendon reflexes.
• The levels of specific cells in your blood using occasional blood tests. A blood test may also show changes in the way the liver is working and occasionally the liver may stop working.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store hydroxychloroquine sulfate

Keep out of the sight and reach of children.

Do not use hydroxychloroquine sulfate after the expiry date which is stated on the blister and carton after EXP. The expiry date refers to the last day of that month.

Store below 25°C.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information

What Hydroxychloroquine sulfate 200mg film-coated Tablets contain

• Each tablet contains 200mg of the active substance, hydroxychloroquine sulfate.
• The other ingredients are lactose monohydrate, maize starch, magnesium stearate, polypovidone, hypromellose, macrogol and titanium dioxide (E171).